You may have a Genital Herpes infection

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A young writer to the Check Up column is confused about what action she should take about a recurring vaginal problem. During some months, she sees a rash resembling what she thinks is herpes simplex on her the vulva (outer lips covering the vagina). This has been happening for some time. She had visited her doctor some months ago and was told that the results were "all good" and negative for all the diseases the doctor had tested for, but, at times, the burning rash recurs. Her partner is pressuring her for sex which she is inclined to give him, but what about the rash on the genitals? Could this still be something which is catching?

Check Up would suggest that this young lady avoids sex until the cause of the genital rash has been determined. She seems still concerned that the burning rash may be due to a herpes simplex 2 (genital herpes) infection, and she may very well be correct!

Prevention of the spread of the herpes simplex virus (HSV) is most desirable and it must be recognised that several of the tests which are available to test for this virus can, at times, give a falsely negative result and thus allow for the continued spread of the virus. Already, 60 to 90 per cent of female commercial sex workers have been documented to have HSV 2 infection, and many people in the general population become infected early.

IgG ANTIBODIES

More than five to nine per cent of teenagers have already been infected with the genital herpes virus, while 10 per cent of college students are shown to be infected. It has also been shown that, in some cases, the anti-bodies tested in the blood (IgG antibodies) for HSV can first appear two to three months, and up to six months, after the infection took place. A lot of physicians do only the IgG blood test because of the expense involved in doing both tests and the assumption that after two to three weeks, the IgG test must be positive if the virus is present. It is therefore very important to also do the HSV IgM test, especially when your eyes are telling you a story which is not matching up with the test results obtained. The IgM test is positive in the early stages of the infection only so, when in doubt, the doctor should request that BOTH IgG and IgM HSV tests be done or repeat the IgG test later.

It is not commonly known that a herpes infection can affect the infected individual fairly seriously with headaches, tiredness, and fever lasting up to three weeks and that meningitis (inflammation of the lining of the brain) occurs in 10 per cent of men and an even higher percentage of women who are newly infected.

Recurring episodes tend to be shorter, but nearly all persons will see unpredictable recurrences during the year immediately following the first symptoms. Also, some individuals will shed the virus at times without showing any recognisable symptoms. These unrecognised infections and shedding of the virus play a major factor in the transmission of the disease.

This unpredictable nature is, of course, why so much psychosocial and psychosexual distress occurs in association with this sexually transmitted infection.

Daily treatment with acyclovir or valaciclovir reduces recurrence and viral shedding by as much as 94 per cent while taking the medication, but viral shedding often resumes at some point after the treatment is discontinued.

It would be best for this writer to return to her physician or gynaecologist for a new assessment, testing and treatment for what may well be the recurrence of a herpes simplex genital infection. Sexual activity should be curtailed while any symptoms persist.